| NPI | 1083193114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: RI CSW03186) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA LCI12800718) |
| 101YM0800X Counselor Mental Health (Licence: LA 10551) | |
| 101YP2500X Counselor Professional (Licence: DE Q0000185) | |
| 171M00000X Case Manager/Care Coordinator (Licence: GA G0088) | |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2023-11-24 |