| NPI | 1710412820 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16163) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 17352) |
| 101YP2500X Counselor, Professional (Licence: WI 3310) | |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2017-05-03 |