| NPI | 1316288640 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: LA 5468) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: LA 5468) |
| Enumeration Date | 2013-03-12 |
| Last Update Date | 2026-07-14 |