| NPI | 1366682197 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 9741) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MA 1344AL) |
| 101YM0800X Counselor Mental Health (Licence: MA 6906) | |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2013-12-10 |