| NPI | 1205157021 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-12786) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-11482) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2013-05-31 |