| NPI | 1811299126 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 3184-57) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 4407-125) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15657-131) | |
| Enumeration Date | 2010-11-19 |
| Last Update Date | 2014-09-02 |