| NPI | 1912442120 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MT BBH-LCPC-LIC-20949) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL 21795) |
| Enumeration Date | 2016-12-23 |
| Last Update Date | 2024-09-10 |