| NPI | 1417072398 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC CCAS 104) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC LPC 2013) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2007-07-08 |