| NPI | 1205063310 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC1504) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA201) |
| 101YP2500X Counselor, Professional (Licence: NC 60402) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2009-06-16 |