| NPI | 1497816615 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MA 06-101) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MA 6130) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 2210) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2010-11-17 |