| NPI | 1790345973 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: GA PSY004509) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 11866) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2022-05-05 |