| NPI | 1407602808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: GA LPC014633) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: GA LPC014633) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: GA LPC014633) | |
| 101YM0800X Counselor Mental Health (Licence: GA LPC014633) | |
| 101YS0200X Counselor School (Licence: GA LPC014633) | |
| Enumeration Date | 2024-04-26 |
| Last Update Date | 2024-04-26 |