| NPI | 1447555347 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MINDY SEREMBO Credentialing Specialist 888-924-3627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| 104100000X Social Worker | |
| 163WP0808X Registered Nurse, Psych/Mental Health | |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2026-05-12 |