The holder whose full name is Nitza, Amy Gibson,come from Fort Wayne IN,hold the Temp Mental Hlth Coun Permit license(NO.99012955A) which status is Superceded.
| Name | Nitza, Amy Gibson |
|---|---|
| License Number | 99012955A |
| License Type | Temp Mental Hlth Coun Permit |
| License Status | Superceded |
| City | Fort Wayne |
| State | IN |