| NPI | 1578737177 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CP00001454) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00001454) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2008-04-15 |