| NPI | 1104206085 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 12079) |
| 101YM0800X Counselor, Mental Health (Licence: ID 5898) | |
| 101YM0800X Counselor, Mental Health (Licence: NC A12079) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2018-07-17 |