| NPI | 1154893337 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CT 10410) |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: CT 10410) |
| 101YM0800X Counselor Mental Health (Licence: CT 10410) | |
| Enumeration Date | 2018-12-28 |
| Last Update Date | 2018-12-28 |