| NPI | 1841364767 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: WV 388) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WV 388) |
| 103T00000X Psychologist (Licence: WV WV # 388) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2007-07-08 |