| NPI | 1619050945 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA 6449) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MA 573) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2010-02-08 |