| NPI | 1962675157 |
|---|---|
| Former Name | MARIE CECILIA DOMINIQUE VON WALTHER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 110366U) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2013-10-28 |