| NPI | 1558403451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KORINNE GONGOS Mental Health Therapist 440-285-3568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: OH C.0500215.TEMP) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2020-08-22 |