| NPI | 1124688643 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 828) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2024-09-18 |