| NPI | 1205472321 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATEASA LINETTE MOORE Licensed Clinical Social Worker 231-515-2055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2019-11-24 |
| Last Update Date | 2019-11-24 |