| NPI | 1629314851 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: GA LPC006107) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: GA CCAADC-C0075) |
| Enumeration Date | 2012-12-16 |
| Last Update Date | 2012-12-16 |