| NPI | 1699651364 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA LMHC10003817) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC01097200) |
| Enumeration Date | 2025-08-15 |
| Last Update Date | 2025-08-15 |