| NPI | 1861629693 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA 005175) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 3976) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA C0049) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA 037) | |
| 101YP2500X Counselor, Professional (Licence: GA 00016175) | |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2010-05-12 |