| NPI | 1699322248 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ID LPC-7344) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 014754) |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2024-07-12 |