| NPI | 1962078717 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2022-08-09 |