| NPI | 1700802238 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS ----) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS 222) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2007-07-08 |