NPI | 1821440389 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0014820) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0001051) |
101YM0800X Counselor, Mental Health (Licence: CO LPC.0014820) | |
Enumeration Date | 2016-07-08 |
Last Update Date | 2024-11-18 |