| NPI | 1376695742 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 4151-123) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MN 300436) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 13911) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2010-01-08 |