| NPI | 1710979679 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TN PE1167) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TN LDC287) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2007-07-09 |