| NPI | 1073157657 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW128590) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW92272) |
| 104100000X Social Worker (Licence: CA ASW92272) | |
| Enumeration Date | 2019-11-06 |
| Last Update Date | 2025-02-12 |