| NPI | 1134626583 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: KY 05221) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AR E-12645) |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2022-07-07 |