| NPI | 1245940840 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JAMES RUSSELL Clinical Director/Owner 631-579-2734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2022-12-05 |