| NPI | 1972956241 |
|---|---|
| Other Name | MIA PARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60690329) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2017-03-29 |