| NPI | 1275028508 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 7797) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 7797-125) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16446-132) | |
| 101YM0800X Counselor, Mental Health (Licence: WI 7797-125) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WI 7797-125) | |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2025-05-23 |