| NPI | 1104473651 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 8562-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 8562) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 19659-130) | |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2022-07-11 |