| NPI | 1366019275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY GENTRY Owner 631-617-1487 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2021-06-09 |