| NPI | 1255602132 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CO LPC-6338) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACC-7281) |
| Enumeration Date | 2012-01-24 |
| Last Update Date | 2012-10-06 |