| NPI | 1477021186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILLIAN E KELLY Authorized Official 339-987-0336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2018-11-12 |
| Last Update Date | 2023-11-27 |