| NPI | 1043304835 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOYELLE REED Office Manager 251-776-1217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AL 504) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: AL 593) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2010-09-17 |