| NPI | 1689181620 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA LAC-5132) |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2023-04-04 |