| NPI | 1023548617 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-21366) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A12364) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2017-06-15 |