| NPI | 1982315131 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CK61635927) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 10-06-42) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2022-12-08 |
| Last Update Date | 2025-02-17 |