| NPI | 1245834787 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WV 2439) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WV 13-301) |
| Enumeration Date | 2020-11-25 |
| Last Update Date | 2021-11-24 |