| NPI | 1568036465 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT 43493) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT 43492) |
| 1041C0700X Social Worker, Clinical (Licence: MT BBH-LCSW-LIC-62712) | |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2024-10-17 |