| NPI | 1629061221 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD LPCMH2116) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: 45265) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SD 9605696) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ICADC2245) | |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2012-03-22 |