| NPI | 1861517492 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WV 1815) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WV 1815) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WV 04-301) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2020-11-12 |