| NPI | 1619843117 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0023302) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0021483) |
| Enumeration Date | 2025-10-13 |
| Last Update Date | 2026-01-20 |