| NPI | 1306052394 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA 4356) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA APPLIED FOR) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-07-09 |