| NPI | 1962673145 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MT BBH-LCPC-LIC-7831) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CO LPC-4925) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO ACC-7079) | |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2016-10-12 |