| NPI | 1861515363 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301002288) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MI 6801019150) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2007-07-08 |