| NPI | 1639352578 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 6803) |
| Additional Taxonomies | 251S00000X (Licence: NC 6803) |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NC 6803) | |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2008-09-03 |