| NPI | 1205472370 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ID 11506) |
| 101YM0800X Counselor Mental Health (Licence: ID LPC-7988) | |
| Enumeration Date | 2019-11-22 |
| Last Update Date | 2021-03-10 |