| NPI | 1821396219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ID 6662) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MT BBH-LCPC-LIC-23179) |
| Enumeration Date | 2011-03-09 |
| Last Update Date | 2018-03-30 |