| NPI | 1780685594 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WY LAT 031) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WY LMFT028) |
| 101YP2500X Counselor, Professional (Licence: WY 194) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2007-07-08 |