| NPI | 1255719209 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA2130) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LGP6096) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2015-05-11 |