| NPI | 1831212646 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD 0257) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD 0257) |
| 101YM0800X Counselor, Mental Health (Licence: MD 0257) | |
| 363A00000X Physician Assistant (Licence: MD S000050 Psy. Assist) | |
| Enumeration Date | 2007-04-08 |
| Last Update Date | 2012-09-28 |