| NPI | 1114570611 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MD LGP13409) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2023-01-31 |