| NPI | 1902114820 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA460) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC1779) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2021-01-22 |