| NPI | 1104588177 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: MO 2821) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 4486) |
| 175T00000X Peer Specialist (Licence: 10017) | |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: MO 2821) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MO 2821) | |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2021-10-07 |