| NPI | 1922660646 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 11685) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101YM0800X Counselor, Mental Health (Licence: NE 11916) | |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2022-03-14 |