| NPI | 1164729679 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: TX 67405) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 67405) |
| Enumeration Date | 2011-02-17 |
| Last Update Date | 2011-02-17 |