| NPI | 1508230632 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 5809 125) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 5809 125) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 5809 125) | |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2015-12-01 |