| NPI | 1619868957 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 17060) |
| Enumeration Date | 2025-07-14 |
| Last Update Date | 2026-03-16 |