| NPI | 1649648072 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS 2902) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 10651) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 1412) | |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2016-04-18 |