| NPI | 1114769403 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAYTON WILSON Sole Member 734-395-3298 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-06-10 |
| Last Update Date | 2024-10-01 |