| NPI | 1063637015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDANNA FERN WASILESKU Owner 619-697-0470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-08-22 |