| NPI | 1427813526 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2024-02-27 |