| NPI | 1619982428 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-11527) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-1112) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2007-07-08 |