| NPI | 1932443009 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP5637) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA CADC 4441) |
| 101YP2500X Counselor, Professional (Licence: PR PC000514) | |
| 103TC0700X Psychologist, Clinical (Licence: NC 4279) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2019-06-05 |