| NPI | 1215405287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON FREEMAN Therapist 315-703-0168 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2022-12-22 |