NPI | 1043763675 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: MI 6801100067) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6801100067) |
Enumeration Date | 2016-08-01 |
Last Update Date | 2016-08-01 |