| NPI | 1164845624 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401011876) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 2-01230) |
| Enumeration Date | 2014-02-03 |
| Last Update Date | 2014-02-26 |