| NPI | 1063921740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES J. CORBALLY Sole Owner 802-281-3330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0117025) |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2022-07-21 |