| NPI | 1790066165 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: NM X-08775) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM X-07511) |
| Enumeration Date | 2011-08-30 |
| Last Update Date | 2014-11-21 |