NPI | 1053863951 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC012673) |
Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) (Licence: GA LPC012673) |
101YP2500X Counselor, Professional (Licence: GA APC005267) | |
101Y00000X Counselor (Licence: GA LPC012673) | |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA LPC012673) | |
Enumeration Date | 2016-10-27 |
Last Update Date | 2022-01-25 |