| NPI | 1174092159 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 15477) | 
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL 15477) | 
| Enumeration Date | 2018-11-19 | 
| Last Update Date | 2018-11-19 |