| NPI | 1104586106 |
|---|---|
| Former Name | KENNETH BROWN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 5157-226) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 19332-130) |
| Enumeration Date | 2021-12-19 |
| Last Update Date | 2021-12-19 |