| 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 |