| NPI | 1205304615 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 29107) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2023-10-31 |