| NPI | 1508619214 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 0021765) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPCC.0021765) |
| 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0021765) | |
| Enumeration Date | 2024-04-10 |
| Last Update Date | 2025-01-14 |