| NPI | 1992984355 |
|---|---|
| Former Name | KIM RENEE PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6401010410) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401010410) |
| 101YM0800X Counselor, Mental Health (Licence: MI 6401010410) | |
| Enumeration Date | 2007-11-01 |
| Last Update Date | 2012-03-06 |