| NPI | 1104679422 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Additional Taxonomies | 261QD1600X Clinic/Center Developmental Disabilities |
| Enumeration Date | 2024-04-08 |
| Last Update Date | 2024-05-29 |