| 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 |