NPI | 1649604547 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC 51586) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA LPC 167) |
101YM0800X Counselor, Mental Health (Licence: CA LPC 167) | |
101YP2500X Counselor, Professional (Licence: CA LPC 167) | |
Enumeration Date | 2013-08-27 |
Last Update Date | 2013-08-27 |