| NPI | 1164601787 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MD 210310714) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: DC ADD14102) |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2021-08-25 |