| NPI | 1013627827 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SURAJI WAGAGE Director, Clinical Psychologist 844-287-4228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2022-12-02 |
| Last Update Date | 2024-09-17 |