| NPI | 1750909594 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 12959) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MS 20-125500) |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2022-06-21 |