| NPI | 1801153861 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: SC 7241) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SC 311) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 60115) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 11122110) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 014904) | |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2023-03-15 |