| NPI | 1063623064 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL 2628) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: FL SW 8187) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2007-07-08 |