| NPI | 1215240775 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: GA PSY003639)  | 
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA PSY003639)  | 
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| Enumeration Date | 2010-07-26 | 
| Last Update Date | 2019-08-14 |