| NPI | 1548769680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY BOWDEN CEO 857-242-1139 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: KS 40088) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: KS 40088) |
| 405300000X Prevention Professional | |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2018-02-05 |