| NPI | 1801742820 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 26-QMHA-R-8310) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-25-6215) |
| Enumeration Date | 2026-03-10 |
| Last Update Date | 2026-03-10 |