| NPI | 1225856008 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEVI LIPOVENKO CEO 848-210-0028 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| 1041C0700X Social Worker Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2024-09-30 |
| Last Update Date | 2024-09-30 |