| NPI | 1912368317 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IA 01491) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IA 00994) |
| Enumeration Date | 2016-03-11 |
| Last Update Date | 2016-03-11 |