NPI | 1972003911 |
---|---|
Former Name | AMY EVERSOLE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0015056) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2018-02-16 |
Last Update Date | 2023-10-26 |