| NPI | 1982766713 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT 1067) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: MT 887) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2007-07-09 |