| NPI | 1104229038 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MN 1439) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MN 302918) |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2014-10-07 |