| NPI | 1659886695 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL 4337) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AL 4337) |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2022-04-03 |