| NPI | 1154937290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY NICOLE ALVIA BRODIE WALKER Director/Licensed Psychologist 754-801-9750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2020-09-22 |
| Last Update Date | 2020-09-22 |