| NPI | 1649978941 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: VA 88-2017627) |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: VA 6764-07-006) | |
| Enumeration Date | 2023-02-16 |
| Last Update Date | 2023-02-16 |