| NPI | 1013465855 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WV 1698) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WV 05-306) |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2016-09-21 |