| NPI | 1962077438 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A22475) |
| Additional Taxonomies | 247200000X Technician, Other |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2026-05-20 |