| NPI | 1104989540 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: RI ISW01122) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA 1029405) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2007-07-08 |