| NPI | 1912315920 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC4451) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD AC2029) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2014-07-23 |