| NPI | 1679120729 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: UT 11290032-6009) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 11290032-6019) |
| Enumeration Date | 2019-08-23 |
| Last Update Date | 2023-12-28 |