NPI | 1992681530 |
---|---|
Former Name | TINA LOUISE GAGNON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A065680225) |
Enumeration Date | 2025-08-11 |
Last Update Date | 2025-08-11 |