| NPI | 1720169634 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 12695) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 3500-123) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2007-07-08 |