| NPI | 1508242090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY CHERYL GHOLSON CEO/Clinical Social Worker 217-202-8433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IL 149014440) |
| Enumeration Date | 2015-08-06 |
| Last Update Date | 2015-08-06 |