| NPI | 1477748374 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: KS A0100482) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: KS 1892) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2012-03-12 |