| NPI | 1780294868 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MI 6451022370) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2022-08-18 |