| NPI | 1609078500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: GA LPC007769) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: C0082) |
| 106H00000X Marriage & Family Therapist (Licence: GA LMFT001409) | |
| Enumeration Date | 2007-06-03 |
| Last Update Date | 2025-06-04 |