| NPI | 1245766690 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY JAMES DEVINE Lpc 267-428-0321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC007555) |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2024-08-27 |