| NPI | 1629213798 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 5462) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: NC 5462) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NC 5462) | |
| 103TE1100X Psychologist Exercise & Sports (Licence: NC 5462) | |
| 103TF0000X Psychologist Family (Licence: NC 5462) | |
| 103TH0004X Psychologist Health (Licence: NC 5462) | |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2019-02-18 |