| NPI | 1184095556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 1603) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 343900000X Non-emergency Medical Transport (VAN) (Licence: LA 010494439) | |
| 171000000X Military Health Care Provider | |
| 171M00000X Case Manager/Care Coordinator | |
| 175T00000X Peer Specialist | |
| 225C00000X Rehabilitation Counselor | |
| 101Y00000X Counselor | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| 101YP1600X Counselor, Pastoral | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TC1900X Psychologist, Counseling | |
| 101YP2500X Counselor, Professional (Licence: LA 5006) | |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2021-01-12 |