| NPI | 1962655134 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT 1039) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MT 21203) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT 1276) | |
| Enumeration Date | 2008-10-31 |
| Last Update Date | 2012-03-08 |