| NPI | 1902136542 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 0296) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: KY 1823) |
| Enumeration Date | 2010-01-04 |
| Last Update Date | 2018-09-19 |