| NPI | 1255678777 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VT 068.0000694) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 000450) |
| Enumeration Date | 2013-01-04 |
| Last Update Date | 2013-01-04 |