| NPI | 1043002470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QR0800X Clinic/Center, Recovery Care |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 175T00000X Peer Specialist (Licence: NC 2025-13014-01) | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 177F00000X Lodging | |
| 251B00000X Case Management | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2025-05-21 |
| Last Update Date | 2026-08-25 |