| NPI | 1639555253 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60526474) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 300990) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2015-08-05 |