| NPI | 1972363208 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 1660) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 27601) | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2024-03-21 |
| Last Update Date | 2024-03-21 |