| NPI | 1942646492 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MT BBH-LCPC-LIC-30458) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MT LAC-LAC-LIC-1364) |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2019-11-11 |