NPI | 1578017885 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor Professional (Licence: LA 7000) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: LA 7000) | |
101YM0800X Counselor Mental Health | |
101YM0800X Counselor Mental Health (Licence: LA 7000) | |
Enumeration Date | 2016-08-04 |
Last Update Date | 2023-10-26 |