| NPI | 1194117689 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 300093BN) | |
| Enumeration Date | 2015-02-20 |
| Last Update Date | 2019-06-18 |