| NPI | 1528238292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: KY KY-0665) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 103169) |
| 101Y00000X Counselor (Licence: FL MH17156) | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KY 164838) | |
| 101YM0800X Counselor Mental Health (Licence: FL MH17156) | |
| 101YM0800X Counselor Mental Health (Licence: KY 103169) | |
| 101YP2500X Counselor Professional (Licence: KY 103169) | |
| 101YP2500X Counselor Professional (Licence: FL MH17156) | |
| Enumeration Date | 2008-03-09 |
| Last Update Date | 2022-11-17 |