| NPI | 1962912410 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WV 2173) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WV 15-313) |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2017-10-10 |