| NPI | 1285023655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH JARRELL WALLER Therapeutic Mentor 617-987-5977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2015-01-22 |