| NPI | 1912008053 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 791) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 394A) |
| 101YM0800X Counselor, Mental Health (Licence: MA 5663) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |