| NPI | 1396055364 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: PR 359) | 
| Additional Taxonomies | 103T00000X Psychologist | 
| 103TH0100X Psychologist, Health Service | |
| Enumeration Date | 2010-10-08 | 
| Last Update Date | 2010-10-08 |