| NPI | 1538944913 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL 04993) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AL 04993) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AL 04993) | |
| 101YM0800X Counselor, Mental Health (Licence: AL 04993) | |
| Enumeration Date | 2023-08-25 |
| Last Update Date | 2023-08-25 |