NPI | 1619496122 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 178.013194) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 17852-130) |
Enumeration Date | 2017-09-15 |
Last Update Date | 2018-02-05 |