| NPI | 1740638626 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IA 079016) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IA 806491) |
| 101YP2500X Counselor Professional (Licence: MO 2016013351) | |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2018-08-14 |