| NPI | 1780119503 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701006784) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 11172) |
| 101YP2500X Counselor, Professional (Licence: TX 49234) | |
| Enumeration Date | 2017-04-30 |
| Last Update Date | 2017-04-30 |