| NPI | 1194105122 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ 20753) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 12811) |
| 101YP2500X Counselor, Professional (Licence: TX 69392) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2022-09-28 |