NPI | 1487090841 |
---|---|
Entity Type | Organization |
Authorized Contact | DEMARKUS PHANELSON Owner 276-618-0759 |
Organization Subpart ? | No |
Primary Taxonomy | 251S00000X |
Additional Taxonomies | 1041C0700X Social Worker, Clinical |
Enumeration Date | 2013-05-13 |
Last Update Date | 2013-05-13 |