| NPI | 1083765507 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CO 4653) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO 6662) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2020-10-05 |