| NPI | 1861011363 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 19002) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 4606) |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2021-01-14 |