| NPI | 1124601448 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH MACKIE President 458-230-5248 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2021-05-04 |