| NPI | 1558894162 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MN cc01559) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 304506) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2018-01-29 |