| NPI | 1043973670 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 251300000X Local Education Agency (LEA) |
| 251S00000X | |
| Enumeration Date | 2021-10-20 |
| Last Update Date | 2021-10-20 |