| NPI | 1790858389 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 465) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 45) |
| 101YM0800X Counselor, Mental Health (Licence: NE 1121) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2012-05-01 |