| NPI | 1407059454 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 63034) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 3429) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 10370) | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2019-02-05 |