| NPI | 1114064250 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-11821) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-11136) |
| 1041C0700X Social Worker, Clinical (Licence: ME LC4133) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2007-07-08 |