NPI | 1669770426 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: CA 1135-031613A) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA CORPHQ-1135-031613A) |
320800000X Community Based Residential Treatment Facility, Mental Illness | |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 1135-031613A) | |
Enumeration Date | 2011-03-03 |
Last Update Date | 2012-06-15 |