| NPI | 1275054140 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0015057) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0001565) |
| 101Y00000X Counselor (Licence: CO LPCC.0014910) | |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2022-07-21 |