| NPI | 1225456460 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| 347C00000X Private Vehicle (Licence: TX 25894411) | |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2021-08-23 |