| NPI | 1720139769 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 4065) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 19803) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2007-07-08 |