| NPI | 1639384365 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OR 1478) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: OR 1478) |
| 103TP2701X Psychologist Group Psychotherapy (Licence: OR 1478) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2009-04-10 |