NPI | 1568453645 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 3142) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NC 3142) |
103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NC 3142) | |
Enumeration Date | 2005-10-29 |
Last Update Date | 2012-09-17 |