| NPI | 1902166648 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS LPC1014) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS LAC642) |
| Enumeration Date | 2012-05-28 |
| Last Update Date | 2014-05-09 |