| NPI | 1104191501 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MA 115897) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 115897) |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2015-01-09 |