| NPI | 1629775846 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 251B00000X Case Management |
| 251S00000X | |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| Enumeration Date | 2023-02-08 |
| Last Update Date | 2023-02-08 |