| NPI | 1356333595 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NE CCGC 021) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE LADC) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA ACADC) | |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2007-07-08 |