| NPI | 1144856303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 15761) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 15761) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC lcas26407) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 26407) | |
| 101YP2500X Counselor, Professional (Licence: NC A15761) | |
| 101YP2500X Counselor, Professional (Licence: NC 15761) | |
| Enumeration Date | 2020-03-19 |
| Last Update Date | 2023-05-30 |