| NPI | 1619596020 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 261QH0100X Clinic/Center, Health Services | |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2026-04-23 |