| NPI | 1124466479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA L DOUGHERTY Executive Director 267-642-4039 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2013-06-10 |