| NPI | 1265783427 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16704-130) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 1610-226) |
| 101YP2500X Counselor, Professional (Licence: WI 1610-226) | |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2015-03-20 |