| NPI | 1316364375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY KOEKKOEK Psychotherapist/Dietitian 508-276-1743 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 8490) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2017-04-04 |