| NPI | 1356692412 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 6711029-6006) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 015403) |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2012-09-28 |