| NPI | 1770936619 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2021027885) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS LCAC702) |
| 103TC0700X Psychologist, Clinical (Licence: CA 28438) | |
| 103TC0700X Psychologist, Clinical (Licence: KS 2487) | |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2021-09-02 |