NPI | 1982923769 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NJ 37LC00095800) |
Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NJ 37PC00170000) |
Enumeration Date | 2010-05-19 |
Last Update Date | 2014-03-25 |