| NPI | 1902196389 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 005916600) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: FL 007376700) |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2017-06-21 |