| NPI | 1609359603 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A15460) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-09-14 |
| Last Update Date | 2020-01-28 |