| NPI | 1609980275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MA LMHC #896) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 896) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 659) | |
| 101Y00000X Counselor (Licence: MA 896) | |
| 101Y00000X Counselor (Licence: MA LADC #659) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2024-08-27 |