| NPI | 1457446700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEFAN MASSONG Practice Manager 228-872-8429 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2013-07-02 |