NPI | 1629453014 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 010301) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 001719) |
101YM0800X Counselor, Mental Health (Licence: CT 001719) | |
104100000X Social Worker (Licence: CT 001719) | |
Enumeration Date | 2015-07-27 |
Last Update Date | 2018-08-30 |