NPI | 1104064740 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6361000784) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401007071) |
103TC1900X Psychologist, Counseling (Licence: MI 6301010873) | |
Enumeration Date | 2009-02-03 |
Last Update Date | 2023-04-14 |