| NPI | 1700240728 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC 1875) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 4566) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: DC 1875) | |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2018-03-29 |