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 Clinic/Center, Mental Health (Including Community Mental Health Center) |
Enumeration Date | 2021-02-21 |
Last Update Date | 2022-02-09 |