| NPI | 1629442231 |
|---|---|
| Former Name | SEAN SMITH |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IL 149019678) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IL 34978) |
| 104100000X Social Worker (Licence: DC LG50081367) | |
| 104100000X Social Worker (Licence: MD 20792) | |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2021-04-22 |