| NPI | 1679624100 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY002970) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: GA PSY002970) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: GA PSY002970) | |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2007-09-10 |