| NPI | 1912176405 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ME CC3822) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ME XL3316) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ME CAC4124) | |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2013-08-22 |