| NPI | 1265995062 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 282223) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 267310) |
| 103T00000X Psychologist (Licence: KY 245804) | |
| 103TC0700X Psychologist, Clinical (Licence: KY 266181) | |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2023-02-22 |