| NPI | 1275131559 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 12689) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 175T00000X Peer Specialist | |
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) | |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2024-12-10 |