| NPI | 1518020338 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC4222) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0116501) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2009-05-28 |