| NPI | 1659624716 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MO 2012032159) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MO 4809) |
| Enumeration Date | 2012-10-25 |
| Last Update Date | 2012-10-25 |