| NPI | 1124415641 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: OR C3816) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60342355) |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2015-07-29 |