| NPI | 1316452287 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WY CAP-134) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY PPC-1066) |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2018-09-12 |