| NPI | 1639691132 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC A13016) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C1200554) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-23545) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 141070) | |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2017-07-17 |