| NPI | 1871011486 |
|---|---|
| Former Name | JUSTIN LEE ARRILDT |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAP.0100424) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL ICADC.0000031) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD AC2946) | |
| 175T00000X Peer Specialist (Licence: MD PR0153) | |
| Enumeration Date | 2017-09-04 |
| Last Update Date | 2023-05-20 |