| NPI | 1104938562 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 4605) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1062) |
| 101YP2500X Counselor, Professional (Licence: NC 3) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2016-07-06 |