| NPI | 1184273344 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 3829) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CT 3829) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 3829) | |
| 101YM0800X Counselor, Mental Health (Licence: CT 3829) | |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2024-11-04 |