| NPI | 1548716293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CO NLC.0104613) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO NLC.0104613) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO NLC.0104613) | |
| 101YP2500X Counselor Professional (Licence: CO NLC.0104613) | |
| 101YS0200X Counselor School (Licence: CO NLC.0104613) | |
| 171M00000X Case Manager/Care Coordinator (Licence: CO NLC.0104613) | |
| 174400000X Specialist (Licence: CO NLC.0104613) | |
| 175T00000X Peer Specialist (Licence: CO NLC.0104613) | |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2016-08-31 |