| NPI | 1073010690 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VA 0904010207) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VA 0710000340) |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2018-04-10 |