| NPI | 1164952867 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00743100) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC0224600) |
| 101YM0800X Counselor, Mental Health (Licence: VT 068.0136330) | |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0021628) | |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2024-12-17 |