| NPI | 1306908744 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904005219) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0904005219) |
| 101YP2500X Counselor, Professional (Licence: VA 0904005219) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2009-08-20 |