| NPI | 1568661379 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 0007142) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC 4424) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2022-07-21 |