| NPI | 1508307083 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: UT 8336873-6004) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: UT 8336873-6004) |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2017-03-16 |