| NPI | 1174340053 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LAC-22760) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LAC-22760) |
| 251S00000X (Licence: AZ LAC-22760) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: AZ LAC-22760) | |
| Enumeration Date | 2024-09-23 |
| Last Update Date | 2024-09-23 |