| NPI | 1538580261 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CO 4530) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO 6621) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: CO 907) | |
| 103TC1900X Psychologist Counseling (Licence: CO 5219) | |
| Enumeration Date | 2013-12-24 |
| Last Update Date | 2023-05-10 |