| NPI | 1548450430 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301008679) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI C-00823) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA IC & RC 200542) | |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2008-11-20 |