| NPI | 1568808103 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09930581) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 73882) |
| 101Y00000X Counselor | |
| 101YM0800X Counselor, Mental Health (Licence: CA 73882) | |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2025-01-29 |