| NPI | 1689708521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6803085540) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6803085540) |
| 171W00000X Contractor (Licence: MI 6803085540) | |
| 172V00000X Community Health Worker (Licence: MI 6803085540) | |
| 106S00000X Behavior Technician (Licence: MI 6803085540) | |
| 171M00000X Case Manager/Care Coordinator (Licence: MI 6803085540) | |
| 101YP2500X Counselor, Professional (Licence: MI 6803085540) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6803085540) | |
| 101YM0800X Counselor, Mental Health (Licence: MI 6803085540) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2024-01-24 |