| NPI | 1811946007 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MN 12154) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2007-07-08 |