| NPI | 1497179295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN S CROCKER Owner 842-408-2945 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC MD9308) |
| Enumeration Date | 2014-02-13 |
| Last Update Date | 2014-02-13 |