| NPI | 1659777225 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC8876) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC8876) |
| 363A00000X Physician Assistant (Licence: MD S0000060) | |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2019-07-08 |