| NPI | 1629516786 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AZ lpc15987) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ lisac15048) |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2017-02-08 |