| NPI | 1790397909 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2023-02-14 |