| NPI | 1619553559 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 306840) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2025-04-09 |