| NPI | 1073121083 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C015418) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC22800) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-26522) | |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2025-01-03 |