| NPI | 1619212669 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 104100000X Social Worker | |
| Enumeration Date | 2012-12-03 |
| Last Update Date | 2023-02-22 |