| NPI | 1639477722 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC10408) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LAC11676) |
| Enumeration Date | 2011-03-14 |
| Last Update Date | 2011-03-14 |