| 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 |