| NPI | 1528784568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER DOMBROWSKI Credentialing 267-878-0240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2022-10-12 |
| Last Update Date | 2023-12-26 |