| NPI | 1336503200 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 17620) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 3497 - 226) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2017-04-25 |