| NPI | 1063569796 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ID LCPC-4254) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: ID LPC-3619) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2010-04-08 |