| NPI | 1972972727 |
|---|---|
| Former Name | BROOKE RIDEOUT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 11037A) |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2019-01-30 |