| NPI | 1104219278 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MO 2020029365) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KS 727) |
| 1041C0700X Social Worker Clinical (Licence: KS 4915) | |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2023-10-03 |