| NPI | 1902323249 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL 240586) | 
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: FL 240878) | 
| 251S00000X Community/Behavioral Health (Licence: FL 240937) | |
| Enumeration Date | 2017-08-28 | 
| Last Update Date | 2025-09-16 |