| NPI | 1730723875 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA SW131259) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA SW127698) |
| Enumeration Date | 2019-11-01 |
| Last Update Date | 2019-11-01 |