| NPI | 1104419365 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YVONNE SUZETTE GATES President 618-825-8173 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103T00000X Psychologist | |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2021-02-18 |