| NPI | 1619412491 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16958) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 129567) |
| Enumeration Date | 2017-01-03 |
| Last Update Date | 2017-01-03 |