| NPI | 1619074358 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 17503) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ 17503) |
| 103T00000X Psychologist (Licence: AZ 17503) | |
| 101YM0800X Counselor, Mental Health (Licence: AZ 17503) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AZ 17503) | |
| 208000000X Pediatrics (Licence: AZ 17503) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2025-09-25 |