| NPI | 1366878480 |
|---|---|
| Former Name | CONNOR COLEMAN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C7033) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 12223) |
| 101YP2500X Counselor, Professional (Licence: TX 71590) | |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2024-08-30 |