| NPI | 1467181024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREIK LANCE DOMERESE Owner/Member 816-223-8522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2022-06-15 |