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 |