| NPI | 1447004429 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA LPC9822) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA MAC5688) |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2024-11-10 |