| NPI | 1831375831 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT 1228) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT 1438-LCPC) |
| Enumeration Date | 2008-01-21 |
| Last Update Date | 2009-08-25 |