| NPI | 1013876606 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: CA 23113) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA SUDRCI23113) |
| Enumeration Date | 2026-01-19 |
| Last Update Date | 2026-06-15 |