| NPI | 1649469818 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 4590) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NE 165) |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2023-03-07 |