| NPI | 1902820293 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 4831) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 80318) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 881) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-08 |