| NPI | 1710914874 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NE 1835) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 564) |
| 101YM0800X Counselor, Mental Health (Licence: NE 1835) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2014-01-03 |