| NPI | 1366207417 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AZ LAC-21154) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: AZ LASAC-15497) |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2024-05-07 |