NPI | 1245848134 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 16025) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178014256) |
101YM0800X Counselor, Mental Health | |
101YP2500X Counselor, Professional (Licence: IL 178014256) | |
101YP2500X Counselor, Professional (Licence: SC TLC267PC) | |
Enumeration Date | 2020-07-17 |
Last Update Date | 2022-12-09 |