| NPI | 1891246054 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: ID 6349) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VA 509591) |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2016-10-21 |