| NPI | 1114265857 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 1407252 Certificate) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: 28463 Certificate) |
| Enumeration Date | 2013-01-30 |
| Last Update Date | 2015-03-23 |