| NPI | 1285395970 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 251S00000X Community/Behavioral Health | 
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities | 
| Enumeration Date | 2022-01-04 | 
| Last Update Date | 2022-01-05 |