| NPI | 1124212121 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 4326) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 1123) |
| 101YS0200X Counselor School (Licence: NC XXXXXXX38) | |
| Enumeration Date | 2007-09-01 |
| Last Update Date | 2007-09-01 |