| NPI | 1902182439 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW016627) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA CW016627) |
| 101YM0800X Counselor, Mental Health (Licence: NY R057183) | |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2018-09-28 |