| NPI | 1437582723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC006829) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA LPC 006829) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA LPC 006829) | |
| Enumeration Date | 2013-08-09 |
| Last Update Date | 2015-08-03 |