NPI | 1184012734 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
305R00000X Preferred Provider Organization | |
3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
Enumeration Date | 2015-01-06 |
Last Update Date | 2015-01-06 |