| NPI | 1124580147 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MT 30163) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: SD LPC-MH30818) |
| 101YM0800X Counselor Mental Health (Licence: MT LCPC-31063) | |
| 101YP2500X Counselor Professional (Licence: MT 31063) | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MT 38813) | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2023-03-07 |