| NPI | 1528571940 |
|---|---|
| Former Name | JUSTIN ROSS LEWIS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0016219) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0001282) |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2024-05-09 |