| NPI | 1265663504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC - 11665) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TN LMSW - 8441) |
| Enumeration Date | 2009-08-04 |
| Last Update Date | 2011-11-30 |