| NPI | 1619306867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA csw005857) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA C1303150905) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA 509319) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA C0157) | |
| 104100000X Social Worker (Licence: OH S.1200490) | |
| 1041C0700X Social Worker, Clinical | |
| 1041C0700X Social Worker, Clinical (Licence: CT 8277) | |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2021-08-09 |