| NPI | 1679946412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701006366) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA LCMHC13117) |
| 101YP2500X Counselor, Professional (Licence: UT 12840192-6004) | |
| 101YP2500X Counselor, Professional (Licence: PA PC013732) | |
| 101YM0800X Counselor, Mental Health (Licence: NC 16679) | |
| 101YP2500X Counselor, Professional (Licence: AZ LPC-22948) | |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2026-05-05 |