| NPI | 1962689554 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 301842) |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2023-03-14 |