| NPI | 1114115490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA 1017475) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MA 1018) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2007-10-27 |