| NPI | 1548646714 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MA S47730697) |
| 101YM0800X Counselor, Mental Health (Licence: MA s47730697) | |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2020-10-27 |