| NPI | 1023272903 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 180006396) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.006396) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2018-03-17 |