| NPI | 1376649137 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 016) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS LCAC 520) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2014-12-01 |