| NPI | 1063896561 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH21870) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2024-04-07 |