| NPI | 1104608678 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| Enumeration Date | 2023-10-18 |
| Last Update Date | 2023-10-18 |