| NPI | 1093985012 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-20265)  | 
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-1372)  | 
| Enumeration Date | 2008-03-05 | 
| Last Update Date | 2021-11-15 |