| NPI | 1346634672 |
|---|---|
| Former Name | CASSANDRA SMITH |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 3390) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 12112) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2023-09-20 |