| NPI | 1124398557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERNADETTE DI CARLO Provider 734-845-0793 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801085686) |
| Enumeration Date | 2012-01-02 |
| Last Update Date | 2012-01-02 |