| NPI | 1104393487 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC14672) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2026-05-12 |