| NPI | 1053846824 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE 1851)  | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 1936)  | 
| 101YP2500X Counselor, Professional (Licence: NE 4948)  | |
| Enumeration Date | 2017-04-28 | 
| Last Update Date | 2019-10-08 |