| NPI | 1982936258 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 22600) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PR 2068) |
| 103TC1900X Psychologist, Counseling (Licence: PR 5493) | |
| Enumeration Date | 2010-02-11 |
| Last Update Date | 2023-02-09 |