| NPI | 1396472411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHA FARES Owner 228-465-2524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging |
| 103TE1100X Psychologist, Exercise & Sports | |
| 103TF0200X Psychologist, Forensic | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| Enumeration Date | 2022-08-08 |
| Last Update Date | 2025-08-19 |