| NPI | 1578817011 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NE 9469) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE P-1052) |
| 251S00000X (Licence: NE 261QM0801X) | |
| Enumeration Date | 2012-11-06 |
| Last Update Date | 2012-11-06 |