| NPI | 1053705731 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301008694) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MI 6401004053) |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2015-03-20 |