| NPI | 1063915262 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AL C3411A) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AL 167) |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2020-12-16 |