| NPI | 1295070456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIS RUSSELL Chief Executive Officer 810-257-3736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TM1800X Psychologist Mental Retardation & Developmental Disabilities |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2019-02-15 |