| NPI | 1639520786 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: VT 00714) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VT 068.0126464) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2017-12-18 |