| NPI | 1083157069 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NE 11060) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: FL MH25981) |
| Enumeration Date | 2016-11-23 |
| Last Update Date | 2026-04-21 |