NPI | 1982079588 |
---|---|
Former Name | MARSHA LYNNE DALLAS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI L869068) |
Additional Taxonomies | 101YS0200X Counselor, School (Licence: MI SC0000459) |
101YM0800X Counselor, Mental Health | |
Enumeration Date | 2015-12-08 |
Last Update Date | 2024-08-16 |