| NPI | 1215194063 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL 2637) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AL ADC-564) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2013-04-29 |