| NPI | 1346484185 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: UT 270389-6004) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: UT 270389-6006) |
| 103TS0200X Psychologist School (Licence: UT 35585) | |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2009-04-23 |