| NPI | 1396136503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHAUN BENJAMIN GLOVER Owner 229-869-0464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 9693) |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2015-03-18 |