| NPI | 1023211109 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 15002-131) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WI 7255-123) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2007-07-09 |