| NPI | 1457771677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRIE CROCKER Owner 618-816-1224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2003032196) |
| Enumeration Date | 2014-04-27 |
| Last Update Date | 2025-01-27 |