| NPI | 1134300775 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MN CC01458) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MN 301828) |
| Enumeration Date | 2007-11-26 |
| Last Update Date | 2022-04-08 |