| NPI | 1912243890 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT BBH-LCPC-LIC-64370) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-62683) |
| 101YM0800X Counselor, Mental Health (Licence: MT BBH-PCLC-LIC-57326) | |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: MT NUR-RN-LIC-72572) | |
| Enumeration Date | 2012-12-20 |
| Last Update Date | 2023-11-10 |