| NPI | 1669448304 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA CSW004474) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC C000881) |
| 1041C0700X Social Worker, Clinical (Licence: GA CSW004474) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2022-01-07 |