NPI | 1811614001 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.183785) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OH 2022) |
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: OH QMHS) | |
Enumeration Date | 2022-10-27 |
Last Update Date | 2023-03-13 |