| NPI | 1265969950 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 6319) |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: WI 6319-125) |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2024-04-23 |