The holder whose full name is Southern, Douglas,come from Roswell NM,hold the Temp Mental Hlth Coun Permit license(NO.99029073A) which status is Superceded.
| Name | Southern, Douglas |
|---|---|
| License Number | 99029073A |
| License Type | Temp Mental Hlth Coun Permit |
| License Status | Superceded |
| City | Roswell |
| State | NM |