| NPI | 1508257759 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2016013353) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 285) |
| 101YP2500X Counselor, Professional (Licence: KS 2396) | |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2017-04-06 |