| NPI | 1992908362 |
|---|---|
| Former Name | MARY KINGSTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MN 7805) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 739) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2007-07-08 |