| NPI | 1073121026 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1394940620)  | 
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) | 
| Enumeration Date | 2020-07-16 | 
| Last Update Date | 2020-07-16 |