| NPI | 1679342166 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT BBH-LCSW-LIC-72522) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT BBH-SWLC-LIC-55546) |
| Enumeration Date | 2023-12-26 |
| Last Update Date | 2025-08-06 |