| NPI | 1043876758 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH23302) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: 19-76571) |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2024-03-11 |