| NPI | 1114394020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY LYNN DONAHUE Member 716-308-2443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 056508) |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2015-08-26 |