| NPI | 1033955018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY DUANE CLARK Clinical Social Worker 562-999-2024 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2024-07-08 |
| Last Update Date | 2024-08-21 |