| NPI | 1235707498 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P016302) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC P016302) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-27420) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC LCAS-27420) | |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2021-06-15 |