| NPI | 1285211490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: GA CSW007538) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: GA CSW007538) |
| 101YM0800X Counselor Mental Health (Licence: GA CSW007538) | |
| 101YS0200X Counselor School (Licence: GA CSW007538) | |
| 103K00000X Behavior Analyst (Licence: GA CSW007538) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: GA CSW007538) | |
| 104100000X Social Worker (Licence: GA CSW007538) | |
| 1041S0200X Social Worker School (Licence: GA CSW007538) | |
| 261QD1600X Clinic/Center Developmental Disabilities (Licence: GA CSW007538) | |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2021-03-24 |