| NPI | 1265485643 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LPC3064) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 3064) |
| 101YP2500X Counselor, Professional (Licence: NC 3064) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2019-07-16 |