| NPI | 1528807823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE BANUELOS Owner 401-213-9766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-05-24 |
| Last Update Date | 2024-06-04 |