| NPI | 1487747531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 24279) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TN 91) |
| 101YM0800X Counselor, Mental Health (Licence: NC 24279) | |
| 101YP1600X Counselor, Pastoral (Licence: TN 91) | |
| 104100000X Social Worker | |
| 171M00000X Case Manager/Care Coordinator (Licence: TN 91) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2021-12-15 |