NPI | 1417398447 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TN L000000033783) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TN LDC0000000201) |
101YM0800X Counselor, Mental Health (Licence: TN L000000033783) | |
Enumeration Date | 2013-07-06 |
Last Update Date | 2023-12-06 |