| NPI | 1649886979 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 307214) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-20-134450) |
| Enumeration Date | 2020-09-22 |
| Last Update Date | 2025-01-02 |