| NPI | 1356844849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162185) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY LCSW00001115) |
| 1041C0700X Social Worker, Clinical (Licence: WV DP00946482) | |
| 171M00000X Case Manager/Care Coordinator | |
| 104100000X Social Worker (Licence: OH I.2405472.SUPV) | |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2025-11-20 |