| NPI | 1780571257 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AK 2197887)  | 
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: 2197887)  | 
| Enumeration Date | 2025-06-18 | 
| Last Update Date | 2025-06-18 |