| NPI | 1972907061 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 001564) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IA 001564) |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: IA 001564) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: IA 001564) | |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2025-03-03 |