| NPI | 1225440548 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL IMT2200) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 9096A) |
| 101YP2500X Counselor, Professional (Licence: NC A10704) | |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2014-12-17 |