| NPI | 1205357373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL S R Psychologist 251-344-1482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251S00000X (Licence: AL 330) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2023-03-08 |