| NPI | 1104030386 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: DC PRC822) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: DC PRC822) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2007-07-08 |