| NPI | 1104498658 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Ci48500825) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: 340100AP) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2025-10-03 |