| NPI | 1750612347 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MA 10220) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 1408 AD) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2016-04-13 |