| NPI | 1912363813 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA LPC009314) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: PA 251E00000X) |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2018-08-23 |