| NPI | 1164029344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLEY ANNE COSTELLO Owner/President 774-322-1306 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2020-10-01 |