| NPI | 1447663745 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2018-08-09 |