| NPI | 1821338765 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 01151) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 302869) |
| 101YP2500X Counselor, Professional (Licence: WI 10255-125) | |
| Enumeration Date | 2013-02-28 |
| Last Update Date | 2023-12-20 |