| NPI | 1811244981 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00121500) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NJ 2035) |
| 225800000X Recreation Therapist (Licence: 239) | |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2012-08-08 |