| NPI | 1104473131 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2019-08-23 |
| Last Update Date | 2022-03-08 |