| NPI | 1669957080 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00585900)  | 
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00279900)  | 
| Enumeration Date | 2018-10-02 | 
| Last Update Date | 2018-10-02 |