| NPI | 1538757703 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | KATHLEEN WILSON-PARISH Director/Clinical Supervisor 209-740-9943  | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 101YM0800X Counselor, Mental Health | 
| Enumeration Date | 2021-01-04 | 
| Last Update Date | 2021-01-04 |