| NPI | 1205567260 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA T HERNANDEZ Credential Specialist 331-300-5317 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2022-06-29 |