| NPI | 1972645059 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WV 453) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WV CP00454023) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2008-10-22 |