| NPI | 1770959603 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0710102772) |
| Additional Taxonomies | 104100000X Social Worker (Licence: VA 0903001841) |
| Enumeration Date | 2015-08-14 |
| Last Update Date | 2015-08-14 |