| NPI | 1396597092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAITLEE DERX Lcsw/Owner 716-307-8403 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2024-04-04 |
| Last Update Date | 2024-06-23 |