| NPI | 1164564407 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 840) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 3415) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |