| NPI | 1720135338 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VA 94038) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: VA 0904-003795) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2014-01-30 |