| NPI | 1154976496 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: GA PSY004304) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AL 2195) |
| 103TC0700X Psychologist, Clinical (Licence: GA 004304) | |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2022-02-10 |