| NPI | 1013608314 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 8406) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: WI 100196375) |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2025-06-02 |