| NPI | 1134478696 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: KY 247445) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: KY 247445) |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2023-08-17 |