| NPI | 1124378112 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MO 2012028041) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: KS 2324) |
| Enumeration Date | 2012-09-17 |
| Last Update Date | 2012-09-17 |