| NPI | 1881918944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH10254) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL PMH931) |
| 101YP1600X Counselor Pastoral (Licence: FL 20311) | |
| 101YS0200X Counselor School (Licence: FL ID702838) | |
| 101YS0200X Counselor School (Licence: GA ID702838) | |
| 103TS0200X Psychologist School (Licence: GA EXPIRED) | |
| 1041C0700X Social Worker Clinical (Licence: FL C-BSW) | |
| 1041C0700X Social Worker Clinical | |
| 1041S0200X Social Worker School | |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2022-10-11 |