| NPI | 1104092014 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 001074) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 965) |
| 101YM0800X Counselor, Mental Health (Licence: NE 1139) | |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2025-12-01 |