| NPI | 1174190011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUSTIN DERRICK ROGERS President 424-420-5917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103TP0814X Psychologist Psychoanalysis | |
| 104100000X Social Worker | |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2021-06-09 |