| NPI | 1164918272 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PR 3759) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PR 2263) |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2021-11-01 |