| NPI | 1154679538 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT 9296) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT 1396) |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2015-09-30 |