| NPI | 1790897007 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NE 1202) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NE P527) |
| 101YM0800X Counselor Mental Health (Licence: NE 3064) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2011-06-13 |