| NPI | 1104210707 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 9203) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WI 128789) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 15869) | |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2024-03-13 |