| NPI | 1376039503 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH 1901631) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: OH 1800902) |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2019-01-11 |