| NPI | 1972155810 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MA 1853AD) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 18707) |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2019-11-22 |