| NPI | 1063078251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA MARIA PAYNE Marriage, Family, Child Therapist 442-229-6296 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2019-05-14 |