| NPI | 1962245936 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WI LPC11053-125) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI SAC17110-131) |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2024-06-17 |