| NPI | 1790105062 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AZ LPC-12004) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: 60569) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2014-04-24 |