| NPI | 1639215692 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NY 11333) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY R045023-1) |
| 1041C0700X Social Worker Clinical (Licence: CT 005906) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2007-07-08 |