| NPI | 1831804327 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-24-3445) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L16975) |
| Enumeration Date | 2023-01-18 |
| Last Update Date | 2025-09-06 |