NPI | 1588303069 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0020103) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002373) |
101YM0800X Counselor, Mental Health (Licence: CO LPCC.0018855) | |
Enumeration Date | 2022-06-02 |
Last Update Date | 2025-07-09 |