| NPI | 1982129110 |
|---|---|
| Former Name | EMILY LEESEBERG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 304584) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2017-08-09 |