| NPI | 1194130096 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA CD-0000035)  | 
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DE 750)  | 
| Enumeration Date | 2014-06-30 | 
| Last Update Date | 2014-06-30 |