| NPI | 1447574439 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: WA CP 00004065) | 
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WA LH 00007718) | 
| Enumeration Date | 2010-03-18 | 
| Last Update Date | 2010-03-18 |