| NPI | 1366697179 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 4254) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MA 50030) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 3206) | |
| Enumeration Date | 2008-11-20 |
| Last Update Date | 2008-11-20 |