| NPI | 1659980472 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C7510) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC0018867) |
| 101YM0800X Counselor, Mental Health (Licence: FL mh20830) | |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2025-03-19 |