| NPI | 1194116715 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C6861) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OK 7774) |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2015-02-18 |
| Last Update Date | 2023-08-14 |