| NPI | 1831772813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT BBH-LCPC-LIC-81381) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LIAC15416) |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0023158) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162703) | |
| 101YP2500X Counselor, Professional (Licence: OH E.2505841) | |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2026-01-26 |