| NPI | 1265040190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE MOORE Licensed Clinical Social Worker 224-804-0224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2022-04-20 |