| NPI | 1508335944 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINA PENGE Owner 267-251-2493 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2018-11-14 |