| NPI | 1912686676 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC 365) |
| Additional Taxonomies | 222Q00000X Developmental Therapist (Licence: NC 817210) |
| Enumeration Date | 2023-07-11 |
| Last Update Date | 2023-10-25 |