| NPI | 1619275484 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 3270) | 
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA 3270) | 
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 3270) | |
| 101YM0800X Counselor, Mental Health (Licence: LA 3270) | |
| 101YS0200X Counselor, School (Licence: LA 3270) | |
| 106H00000X Marriage & Family Therapist (Licence: LA 1045) | |
| Enumeration Date | 2011-03-03 | 
| Last Update Date | 2011-03-03 |