| NPI | 1306320064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA LASALA Clinical Social Worker 248-207-1863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2018-09-19 |
| Last Update Date | 2022-01-20 |