| NPI | 1679019079 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMH21839) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| 252Y00000X Early Intervention Provider Agency | |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2022-07-07 |