| NPI | 1982236998 |
|---|---|
| Former Name | ANDREA LEIGH FORMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AR P2306023) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 088760) |
| Enumeration Date | 2020-02-07 |
| Last Update Date | 2023-09-01 |