| NPI | 1649694001 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LGP6232) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD 101YA0400X) |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2015-04-15 |