| NPI | 1578789996 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA 120511) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA 214255) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MA 214255) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2021-12-30 |