| NPI | 1598231136 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OR A14441) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 23-QMHPC-001243) |
| 1041C0700X Social Worker, Clinical (Licence: WI 132672121) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-24-4047) | |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2024-12-13 |