| NPI | 1255941837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AYANA FORDHAM Clinical Director/ Owner 810-275-4206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2020-08-07 |