| NPI | 1124809744 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851122237) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 104100000X Social Worker | |
| Enumeration Date | 2023-10-10 |
| Last Update Date | 2026-05-21 |