| NPI | 1609133495 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ID LCPC 2913) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LCPC 2913) |
| 106H00000X Marriage & Family Therapist (Licence: ID LCPC 2913) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2012-04-18 |