| NPI | 1104487917 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 5380-226) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-06-23 |
| Last Update Date | 2024-02-01 |