NPI | 1558345926 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC009656) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA196) |
101YM0800X Counselor, Mental Health (Licence: PC009656) | |
101YM0800X Counselor, Mental Health (Licence: MD LC2343) | |
101YP2500X Counselor, Professional (Licence: MD LC2343) | |
Enumeration Date | 2005-11-30 |
Last Update Date | 2018-09-26 |