NPI | 1932732435 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TN LDC1143) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist |
101Y00000X Counselor | |
Enumeration Date | 2020-02-13 |
Last Update Date | 2020-02-13 |