| NPI | 1215542733 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMONE LYNN DERKS Clinical Social Worker 906-361-1386 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2020-11-17 |