| NPI | 1124363775 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH18285) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2022025329) |
| 101YP2500X Counselor, Professional (Licence: MO 2022025329) | |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: FL MH18285) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: FL MH18285) | |
| Enumeration Date | 2012-12-10 |
| Last Update Date | 2024-11-10 |