| NPI | 1174051619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY ADLI KANAAN Owner/Partner 269-815-8168 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401012892) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801092614) |
| Enumeration Date | 2017-05-29 |
| Last Update Date | 2020-02-20 |