| NPI | 1376664045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WV 888) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WV 888) |
| 101YM0800X Counselor, Mental Health (Licence: WV 888) | |
| 101YP1600X Counselor, Pastoral (Licence: WV 888) | |
| 101YP2500X Counselor, Professional (Licence: WV 888) | |
| 1041C0700X Social Worker, Clinical (Licence: WV CP00938634) | |
| 106H00000X Marriage & Family Therapist (Licence: WV 888) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2007-07-08 |