Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JAMES AND (CHARMOY, LCSW, LCADC)
Provider Other First Name:
DIANA
Provider Other Middle Name:
LYNNETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW, LCADC
Provider Other Last Name Type Code:
1