| NPI | 1639693591 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KS 05282) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KS 436) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KS 00742) | |
| 104100000X Social Worker (Licence: KS 10435) | |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2022-07-21 |