| 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 |