| NPI | 1720282130 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 1575) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 1028748) |
| 1041C0700X Social Worker, Clinical (Licence: RI ISW01678) | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2007-07-08 |