| NPI | 1528568565 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT BBH-LCPC-LIC-55997) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MT 17-45999) |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2022-06-02 |