| NPI | 1548205289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONITA WICKSTROM President 505-275-7795 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM I4390) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2008-01-29 |