| NPI | 1295410694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTICE GOMES Provider 401-753-8543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker Clinical | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2023-12-04 |