| NPI | 1609566074 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services | 
| Additional Taxonomies | 251E00000X Home Health | 
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA T0628) | |
| Enumeration Date | 2023-05-10 | 
| Last Update Date | 2025-09-09 |