| 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 |