| NPI | 1639731714 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH16885) |
| Additional Taxonomies | 225800000X Recreation Therapist (Licence: NY 62417) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2019-06-28 |