| NPI | 1124598511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YS0200X Counselor, School (Licence: TN 000189998) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TN 000189998) |
| 101YM0800X Counselor, Mental Health (Licence: TN 000189998) | |
| 104100000X Social Worker (Licence: TN 000189998) | |
| 1041C0700X Social Worker, Clinical (Licence: TN 000189998) | |
| 1041S0200X Social Worker, School (Licence: TN 000189998) | |
| 171M00000X Case Manager/Care Coordinator (Licence: TN 000189998) | |
| Enumeration Date | 2018-11-28 |
| Last Update Date | 2018-11-28 |