| NPI | 1144780222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN JOHNSON LOVELACE Billing/Credentialing 731-410-7719 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2019-09-25 |