| NPI | 1467086215 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health (Licence: OR 19-QMHA-I-00257) |
| 376K00000X Nurse's Aide (Licence: OR 201110681CNA) | |
| Enumeration Date | 2020-03-01 |
| Last Update Date | 2021-09-21 |