| 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 |