| NPI | 1174947238 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 304694) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 2611) |
| 1041C0700X Social Worker, Clinical (Licence: MN 24058) | |
| Enumeration Date | 2014-02-10 |
| Last Update Date | 2017-03-30 |