| NPI | 1174695639 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-2200) | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-2200) | 
| Enumeration Date | 2006-11-13 | 
| Last Update Date | 2021-03-02 |