| NPI | 1790093904 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency (Licence: FL IMH8982) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH8982) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2024-09-24 |