NPI | 1700459062 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH19386) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VT 068.0135048TELE) |
101YM0800X Counselor, Mental Health (Licence: UT 13185741-6004) | |
222Q00000X Developmental Therapist (Licence: FL MH19386) | |
Enumeration Date | 2021-07-22 |
Last Update Date | 2025-01-09 |