| NPI | 1285387928 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANEQUIA SEYMORE Licensed Clinical Social Worker 872-243-9945 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2022-02-02 |
| Last Update Date | 2022-05-09 |