| NPI | 1730948241 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: PA BH005163) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: PA BH005163) | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2024-03-18 |
| Last Update Date | 2024-03-23 |