NPI | 1144672122 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 175T00000X Peer Specialist |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002056) |
101YM0800X Counselor, Mental Health (Licence: CO LPCC.0019167) | |
Enumeration Date | 2016-07-01 |
Last Update Date | 2023-03-02 |