NPI | 1770875718 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 4876) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16051-130) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 4876) | |
Enumeration Date | 2011-05-10 |
Last Update Date | 2021-09-30 |