| NPI | 1316221542 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15852-131)  | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 1448-226)  | 
| Enumeration Date | 2011-10-06 | 
| Last Update Date | 2016-08-19 |