| NPI | 1750822714 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MO 2014012324) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MO 8313) |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2021-08-14 |