| NPI | 1609278266 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: OR 12-12-26) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 12-12-26) |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2015-03-13 |