| NPI | 1972801009 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 64882) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: AL 2988) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: GA C0110) | |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2015-12-02 |