| NPI | 1073265377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA ANTOINETTE RUNYAN Clinical Director 725-222-0263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2022-01-19 |
| Last Update Date | 2025-03-03 |