NPI | 1366794349 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-11077) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-1062) |
Enumeration Date | 2012-10-15 |
Last Update Date | 2012-10-15 |