| NPI | 1053594325 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MI 6401010460) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401010460) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MI 6401010460) | |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2007-12-10 |