| NPI | 1346576493 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 302F00000X Exclusive Provider Organization | |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2009-10-26 |