| NPI | 1790343895 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 14673) |
| Additional Taxonomies | 374K00000X (Licence: LA 1222) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2019-07-03 |