| NPI | 1619074523 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 1592) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 3460) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-09 |