| NPI | 1922200815 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 974) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 18524) |
| 101Y00000X Counselor (Licence: LA 2642) | |
| 106H00000X Marriage & Family Therapist (Licence: LA 304) | |
| Enumeration Date | 2007-06-03 |
| Last Update Date | 2019-04-10 |