| NPI | 1114138724 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP5061) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP5061) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2022-09-26 |