| NPI | 1538822754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIA COLES Owner 810-637-1724 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2021-10-14 |
| Last Update Date | 2021-10-15 |