| NPI | 1811349764 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MN CC01257) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MN 303940) |
| Enumeration Date | 2016-07-04 |
| Last Update Date | 2016-07-04 |