| NPI | 1942690870 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 698) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: KS 698) |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2025-07-18 |