| NPI | 1679949226 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IA 078378) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2022-02-09 |