NPI | 1720428972 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT LAC-LAC-LIC-2580) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT BBH-LCPC-LIC-12387) |
Enumeration Date | 2013-07-02 |
Last Update Date | 2017-01-03 |