| NPI | 1508734062 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 251S00000X Community/Behavioral Health | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2025-10-27 |
| Last Update Date | 2025-10-27 |