| NPI | 1811130115 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 64428) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 4844) |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2011-03-11 |