| NPI | 1669824553 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA pc012293) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL tpmc5844) |
| 101YM0800X Counselor, Mental Health (Licence: ID 8671445) | |
| 101YP2500X Counselor, Professional (Licence: SC 1805) | |
| 101YM0800X Counselor, Mental Health (Licence: VT 068.0136061tele) | |
| 101YP2500X Counselor, Professional (Licence: PA pc012293) | |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2025-09-05 |