NPI | 1720104151 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: MA 4075) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 345) |
Enumeration Date | 2007-03-21 |
Last Update Date | 2007-07-08 |