| NPI | 1427427814 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY M MACK Licensed Master Social Worker 734-879-0162 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2024-10-16 |