| NPI | 1386016673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 30664) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 251B00000X Case Management | |
| 101Y00000X Counselor | |
| 171M00000X Case Manager/Care Coordinator | |
| 101YM0800X Counselor, Mental Health | |
| 251C00000X Day Training, Developmentally Disabled Services | |
| 103K00000X Behavior Analyst | |
| 106S00000X Behavior Technician | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2015-10-26 |
| Last Update Date | 2025-09-14 |