| NPI | 1063348142 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: VA 18972-08-014) |
| Enumeration Date | 2026-06-18 |
| Last Update Date | 2026-06-18 |