| NPI | 1134888142 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health (Licence: FL MH19507) |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: FL MH19507) |
| Enumeration Date | 2021-12-17 |
| Last Update Date | 2022-01-19 |