| NPI | 1366317034 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CTB-2026-0212) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 36347) |
| Enumeration Date | 2025-10-10 |
| Last Update Date | 2026-04-30 |