| NPI | 1760230981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A063000723) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: CA 24-CCHW-00011) |
| 251S00000X Community/Behavioral Health (Licence: CA 24-CCHW-00011) | |
| 171M00000X Case Manager/Care Coordinator | |
| 101Y00000X Counselor | |
| 175T00000X Peer Specialist | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2024-05-13 |
| Last Update Date | 2025-10-08 |