| NPI | 1225338825 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: SD LPC1102) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SD 5805) |
| Enumeration Date | 2010-10-28 |
| Last Update Date | 2010-10-28 |