| NPI | 1003315144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY BOWDEN CEO 857-242-1139 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: KS 40088) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: IN 28340) |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2018-02-05 |