| NPI | 1376609487 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00084400) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS007892L) |
| 1041C0700X Social Worker, Clinical (Licence: PA CW000509L) | |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC00389000) | |
| Enumeration Date | 2007-01-01 |
| Last Update Date | 2007-07-08 |