| NPI | 1114268588 |
|---|---|
| Former Name | KEITH HAROLD THIGPEN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA A022760416) |
| Enumeration Date | 2013-03-11 |
| Last Update Date | 2019-12-12 |