| NPI | 1174385892 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WILLIAM VINCENT MACKIE Owner Provider 424-465-2840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic |
| Enumeration Date | 2024-01-29 |
| Last Update Date | 2024-01-29 |