| NPI | 1780665687 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NV 619) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MN LP0146) |
| 106H00000X Marriage & Family Therapist (Licence: NV 0551) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2007-07-08 |