| NPI | 1316625080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DR. KENIESHA JOHNSON Owner 860-680-4240 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 104100000X Social Worker |
| 1041S0200X Social Worker School | |
| 171400000X | |
| 221700000X Art Therapist | |
| Enumeration Date | 2023-07-11 |
| Last Update Date | 2023-07-11 |