| NPI | 1962488403 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 4801-LPC) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 2335-LPA) |
| 101YP2500X Counselor, Professional (Licence: NC 2335) | |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2012-08-01 |