| NPI | 1912060955 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 1961125) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 3494123) |
| 106H00000X Marriage & Family Therapist (Licence: WI 404124) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2007-08-08 |