| NPI | 1124766308 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LAC-22004)  | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM CTB-2024-0512)  | 
| Enumeration Date | 2022-05-26 | 
| Last Update Date | 2025-10-21 |