NPI | 1760971949 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.175455) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CMS) |
101YM0800X Counselor, Mental Health (Licence: QMHS) | |
Enumeration Date | 2018-05-03 |
Last Update Date | 2023-12-08 |