| NPI | 1134530249 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA 3100) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD 0381) |
| 101YP2500X Counselor, Professional (Licence: MD 1164) | |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2014-05-12 |