| NPI | 1316400377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATTY GEORGE Office Manage 324-430-1090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2019-08-19 |