| NPI | 1255397774 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1169) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: WI 607-27) |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2019-07-16 |