| NPI | 1669615100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-29822) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00003698) |
| 101YM0800X Counselor, Mental Health (Licence: WA LH00010663) | |
| 1041C0700X Social Worker, Clinical (Licence: WA LW00009326) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID NAADAC MAC # 507277) | |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2014-08-19 |