NPI | 1770046658 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 35587) |
Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: NY EXEMPT) |
171M00000X Case Manager/Care Coordinator | |
172V00000X Community Health Worker (Licence: NY 3476) | |
175T00000X Peer Specialist (Licence: NY 3476) | |
Enumeration Date | 2019-04-09 |
Last Update Date | 2024-02-08 |