| NPI | 1912042318 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT 1496) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT 1168) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2010-07-29 |