| NPI | 1649574153 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 25578) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 25578) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: TX 25578) | |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2010-12-28 |