| NPI | 1669717914 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 06167)  | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD 06167)  | 
| 106H00000X Marriage & Family Therapist (Licence: MD 06167)  | |
| Enumeration Date | 2012-11-27 | 
| Last Update Date | 2012-11-27 |