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 |