NPI | 1376802165 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WV 1863) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 0011241) |
101YP2500X Counselor, Professional (Licence: MT 1305-LCPC) | |
106H00000X Marriage & Family Therapist (Licence: MT 12) | |
Enumeration Date | 2012-05-14 |
Last Update Date | 2013-12-11 |