| NPI | 1306254909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CT 81483) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 18489) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 81483) | |
| 101YM0800X Counselor, Mental Health (Licence: CT 81483) | |
| 101YP2500X Counselor, Professional (Licence: CT 81483) | |
| 101YP2500X Counselor, Professional (Licence: NC 18489) | |
| 101YS0200X Counselor, School (Licence: CT 81483) | |
| Enumeration Date | 2014-07-27 |
| Last Update Date | 2024-02-14 |