| NPI | 1699018655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TX 29006) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 9684) |
| 1041C0700X Social Worker Clinical (Licence: GA CSW004863) | |
| 1041C0700X Social Worker Clinical (Licence: VA 0904008695) | |
| 171M00000X Case Manager/Care Coordinator (Licence: 4230286) | |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2023-11-28 |