| NPI | 1427442169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LASHEENA DAVIS Owner 209-752-0290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AL C2251A) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: AL C2251A) |
| 101YM0800X Counselor, Mental Health (Licence: AL C2251A) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2015-04-21 |