| NPI | 1376038760 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 1028-125) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 20600-130) |
| 106S00000X Behavior Technician (Licence: WI RBT-18-58203) | |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2025-09-08 |