| NPI | 1588994800 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS LPC 864) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS LCAC 107) |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2015-04-14 |