| NPI | 1396317145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRYN ELAINE ROOSEVELT Owner/Clinician 618-559-1124 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2021-07-12 |