| NPI | 1164615597 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NM I4134) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA 114293) |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2010-04-05 |