| NPI | 1699945402 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WV 756) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WV 94-306) |
| 101YP2500X Counselor, Professional (Licence: WV 1363) | |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2015-05-08 |