NPI | 1649817560 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC10076) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 8159) |
101Y00000X Counselor (Licence: MD LC10076) | |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LC10076) | |
101YP1600X Counselor, Pastoral (Licence: MD LC10076) | |
Enumeration Date | 2019-12-10 |
Last Update Date | 2021-08-19 |