| NPI | 1295469559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NISA JOHNSON Licensed Clinical Social Worker 309-750-0415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2022-10-26 |