| NPI | 1811716012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 0704005599) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0704005599) |
| Enumeration Date | 2024-10-07 |
| Last Update Date | 2026-06-04 |