| NPI | 1649697129 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT 12397) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MT 4639-LCPC) |
| 1041C0700X Social Worker, Clinical (Licence: WY LCSW-1083) | |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2024-09-25 |