| NPI | 1104031145 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.007724) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL #1117) |
| 103TC0700X Psychologist, Clinical (Licence: CA 10784) | |
| Enumeration Date | 2007-05-12 |
| Last Update Date | 2009-08-03 |