NPI | 1629352117 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: UT 360798-3501) |
Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
101YM0800X Counselor Mental Health (Licence: UT 360798-3501) | |
251S00000X Community/Behavioral Health | |
261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
261QM0855X Clinic/Center Adolescent and Children Mental Health | |
Enumeration Date | 2011-10-04 |
Last Update Date | 2020-09-16 |