| NPI | 1376074476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY G HALES Executive Director 716-465-1108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701006204) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC7200) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2017-03-21 |