| NPI | 1639387970 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS LCPC370) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS LCAC 341) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2011-11-03 |