| NPI | 1316695737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN LEWIS Owner 315-907-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2022-03-15 |
| Last Update Date | 2022-03-15 |