| NPI | 1063889897 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: 4041) |
| 103TH0100X Psychologist, Health Service | |
| 106S00000X Behavior Technician | |
| 374U00000X Home Health Aide (Licence: VA 474713318) | |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2025-07-10 |