| NPI | 1265968267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON NICHOLSEN Owner 347-834-3781 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50080958) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-05-11 |