| NPI | 1104097633 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WV 915) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WV 1779) |
| Enumeration Date | 2008-03-12 |
| Last Update Date | 2008-03-12 |