| NPI | 1265429682 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY7456) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 4722) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL PY7456) | |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2009-09-29 |