| NPI | 1023225174 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 2616) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1980) |
| 164W00000X Licensed Practical Nurse (Licence: WI 24505) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2007-09-11 |