| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health |
| 171M00000X Case Manager/Care Coordinator |
| 175T00000X Peer Specialist |
| 225C00000X Rehabilitation Counselor |
| 251E00000X Home Health |
| 320800000X Community Based Residential Treatment Facility, Mental Illness |
| 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2019-05-25 |
| Last Update Date | 2021-10-17 |