| NPI | 1114113826 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL BLACKMON Executive Director 817-413-9463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 22814) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2007-09-18 |