| NPI | 1528179116 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: KS LCPC 758) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: KS LPC 804) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2009-08-17 |