| NPI | 1720033566 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI LPC 6401003039) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MI CACI100371) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2007-07-08 |