| NPI | 1194078071 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 10739) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: 53372) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 5303) | |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2012-10-17 |