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Individual
MAXINE IIDA
Active
Individual
MAXINE IIDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0704015316
VA
101YM0800X
Mental Health Counselor
Primary
701015941
VA
Other
Enumeration date
01/17/2023
Last updated
05/19/2026
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