| NPI | 1962861559 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 7264) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 7264) |
| Enumeration Date | 2016-02-11 |
| Last Update Date | 2016-02-11 |