| NPI | 1427117621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID ACADC 39) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LCPC 236) |
| 104100000X Social Worker (Licence: ID LSW 1561) | |
| 106H00000X Marriage & Family Therapist (Licence: ID LMFT 2636) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2007-07-08 |