| NPI | 1124460332 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: CA 1083) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 68105) |
| Enumeration Date | 2013-07-29 |
| Last Update Date | 2026-05-06 |