| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TP0016X Psychologist, Prescribing (Medical) |
| 103TP2701X Psychologist, Group Psychotherapy |
| 104100000X Social Worker |
| 106S00000X Behavior Technician |
| 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2022-04-20 |