| NPI | 1194101576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC009102) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA LPC009102) |
| 101YP2500X Counselor, Professional (Licence: MO 2013014380) | |
| 106H00000X Marriage & Family Therapist (Licence: GA LPC009102) | |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2023-10-20 |