| NPI | 1841708013 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.024869) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180.011565) |
| 101YP2500X Counselor, Professional (Licence: IL 178.013411) | |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2022-03-30 |