| NPI | 1285873745 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NM 0176661) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: NM 171007) |
| 171M00000X Case Manager/Care Coordinator (Licence: NM 171007) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA RI-J0811051803) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 014701) | |
| Enumeration Date | 2009-02-06 |
| Last Update Date | 2015-09-22 |