| NPI | 1598507345 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.188815) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH QMHS.HSGED) |
| Enumeration Date | 2024-06-12 |
| Last Update Date | 2024-12-05 |