| NPI | 1790201101 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6361002474) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: 6361002474) |
| 103TC1900X Psychologist Counseling (Licence: MI 6361002474) | |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2024-04-15 |