| NPI | 1114119179 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: SD LPC-MH2172) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: SD 06111289) |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2010-03-05 |