| NPI | 1134714033 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLE OLIVER FRY CEO 909-809-7671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2021-03-03 |
| Last Update Date | 2023-06-02 |