| NPI | 1467951509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY BOWDEN CEO 857-242-1139 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP2701X Psychologist, Group Psychotherapy (Licence: IN 28340) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: IN 28340) |
| 103TF0200X Psychologist, Forensic (Licence: IN 28340) | |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2018-02-05 |