| NPI | 1215297395 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810000289) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: VA 0810000289) |
| 103TF0200X Psychologist Forensic (Licence: VA 0810000289) | |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2012-10-22 |