| NPI | 1184772402 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 961) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 3298) |
| 101YM0800X Counselor, Mental Health (Licence: NE 2612) | |
| 251S00000X Community/Behavioral Health (Licence: MT 15634) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2024-06-04 |