| NPI | 1356565386 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MA 162) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MA 4244) |
| 101YM0800X Counselor Mental Health (Licence: MA 3805) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2007-07-09 |