| NPI | 1649706557 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TN LDC0000001224) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TN LDC1224) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TN LDC1224) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2021-01-29 |