| NPI | 1558395426 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA GA755LPC) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: GA GA539LMFT) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2007-07-08 |