| NPI | 1619221140 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MN 1055) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MN 302949) |
| Enumeration Date | 2012-11-06 |
| Last Update Date | 2012-11-06 |