| NPI | 1073520508 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 011) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 393) |
| 101YP2500X Counselor, Professional (Licence: NE 284) | |
| 101YP2500X Counselor, Professional (Licence: KS 103) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-08 |