| NPI | 1821728593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C019216) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101Y00000X Counselor | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2025-11-04 |