| NPI | 1033635024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY FAORUKI Lcsw 765-513-1822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34006395A) |
| Enumeration Date | 2017-08-21 |
| Last Update Date | 2017-08-21 |