| NPI | 1548151186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE GLYNISE MOORE Clinical Social Worker 708-698-0714 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 252Y00000X Early Intervention Provider Agency | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2025-07-11 |
| Last Update Date | 2026-04-16 |