| NPI | 1194375154 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 12943) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 695243) |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2022-05-10 |