| NPI | 1790763803 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: OH 2978) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: MI 3786) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2011-10-19 |