| NPI | 1316035959 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AZ LPC2508) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC 1466) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2013-05-15 |