| NPI | 1023108875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY ANNE STEVENS Operations Manager 618-407-9363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 060006403) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 060006403) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2015-12-14 |