| NPI | 1881724276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA LADC 1 #55) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA LMHC #542) |
| 106H00000X Marriage & Family Therapist (Licence: MA LMFT #317) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2007-07-08 |