| NPI | 1417674383 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHY GALLEGOS Credentialing Manager 517-483-2461 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2022-10-21 |
| Last Update Date | 2022-10-24 |