| NPI | 1407356439 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist School (Licence: SC 4697) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: SC 4697) |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2020-07-07 |