| NPI | 1174874473 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA MH14010) | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH10399) | 
| 101YS0200X Counselor, School (Licence: FL 716753) | |
| Enumeration Date | 2012-09-26 | 
| Last Update Date | 2017-10-13 |