| NPI | 1023456571 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MT 12178) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MT 2723) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2015-09-09 |