| NPI | 1215089990 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: LA TYPE A. 041732 & 266) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 94) |
| 101YP2500X Counselor, Professional (Licence: LA 266) | |
| 101YM0800X Counselor, Mental Health (Licence: LA 266) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 266) | |
| 101YS0200X Counselor, School (Licence: LA TYPE A. 041732) | |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2011-02-08 |