| NPI | 1710787197 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: LA RN131251) |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2025-03-15 |
| Last Update Date | 2025-07-09 |