| NPI | 1487028569 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NJ 37AC00287900) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37AC00287900) |
| 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00287900) | |
| Enumeration Date | 2015-11-30 |
| Last Update Date | 2015-11-30 |