| NPI | 1639247893 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904000674) |
| 106H00000X Marriage & Family Therapist (Licence: VA 0904000674) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-07-08 |