| NPI | 1356755805 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15891-131) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 5777-125) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2016-01-27 |