| NPI | 1174838569 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: WY COTA789) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WY CAP130) | |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2016-07-13 |