| NPI | 1508979220 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: APRN00185) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: RI PNS00021) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2025-08-11 |