| NPI | 1013537133 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| Enumeration Date | 2020-04-18 |
| Last Update Date | 2021-01-09 |