| NPI | 1639821861 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL 18867) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL MCAP100916) |
| Enumeration Date | 2022-01-19 |
| Last Update Date | 2024-06-26 |