| NPI | 1053085902 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: GA RBT-21-178796) |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2024-06-17 |