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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1346494762
- **Gender:** F
- **Credential:** LISW-CP, LCSW, RD/LD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 14949 | SC | Yes |
| 1041C0700X | Clinical Social Worker | CSW008362 | GA | — |
| 133NN1002X | Nutrition Education Nutritionist | — | NULL | — |
| 133V00000X | Registered Dietitian | 1292 | SC | — |
| 133V00000X | Registered Dietitian | LD002881 | GA | — |
| 133VN1004X | Pediatric Nutrition Registered Dietitian | — | NULL | — |

## Other

- **Enumeration date:** 11/12/2008
- **Last updated:** 01/24/2024