| NPI | 1720719834 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 19589-130) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WI 390358) |
| Enumeration Date | 2022-06-20 |
| Last Update Date | 2022-06-20 |