| NPI | 1063898476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROXXI M DAVIS Owner 309-310-9621 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.015543) |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2015-11-30 |