| NPI | 1912789124 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW22199) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL 5695) |
| 104100000X Social Worker (Licence: FL SW22199) | |
| Enumeration Date | 2023-10-23 |
| Last Update Date | 2023-10-23 |