| NPI | 1205965944 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: LA 1271) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY8486) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2015-02-18 |