| NPI | 1568455947 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NE 466) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 286) |
| 1041C0700X Social Worker Clinical (Licence: NE 1152) | |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2007-07-08 |