| NPI | 1073960837 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 504) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16678-130) |
| 101YP2500X Counselor, Professional (Licence: WI 1757- 226) | |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2016-05-20 |