| NPI | 1104556323 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LGP10726)  | 
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD AC2386)  | 
| Enumeration Date | 2022-06-11 | 
| Last Update Date | 2022-06-11 |