| NPI | 1053849125 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1856) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 307246) | |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2026-05-11 |