| NPI | 1154915122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK JAMES JOHNSON Vice President 708-657-5043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2021-02-21 |
| Last Update Date | 2022-02-09 |