| NPI | 1457321424 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301006804) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: KY 170500) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2020-03-05 |