| NPI | 1619337482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37L00233200) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00233200) |
| 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00590800) | |
| 101YM0800X Counselor, Mental Health (Licence: PA 37PC00590800) | |
| 101YP2500X Counselor, Professional (Licence: NJ PC008591) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NJ 37LC00233200) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NJ 37PC00590800) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NJ 37PC00590800) | |
| 103TF0000X Psychologist, Family (Licence: NJ 37PC00590800) | |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2019-10-18 |