| NPI | 1114455763 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 02169) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 304723) |
| 101YM0800X Counselor, Mental Health (Licence: MN 02169) | |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2025-04-09 |