| NPI | 1023222023 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YS0200X Counselor, School | |
| 104100000X Social Worker (Licence: MI 6801085715) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2023-09-22 |