| NPI | 1235719709 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: VA 0701011999) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0710103774) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0704013062) | |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2023-09-11 |