| NPI | 1508109166 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 128895-121) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 890-226) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: WI 16308-130) | |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2013-04-05 |