| NPI | 1174069488 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: IL 36817) |
| Additional Taxonomies | 101Y00000X Counselor |
| 276400000X Rehabilitation, Substance Use Disorder Unit (Licence: IL 36817) | |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2024-06-08 |