| NPI | 1104105121 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH19876) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2025-02-11 |