| NPI | 1265948145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL L DIDOMINICIS Counselor 224-517-6234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2017-12-14 |
| Last Update Date | 2018-03-17 |