| NPI | 1316462559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOLENE CARTER Practice Owner 618-593-0877 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.012089) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2022-07-21 |