| NPI | 1912653718 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| 405300000X Prevention Professional (Licence: MT BBHBHPSCRT50477) | |
| 171400000X Health & Wellness Coach | |
| 174400000X Specialist | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2022-03-01 |
| Last Update Date | 2024-07-02 |